Social Care: Family Carers

Lord Bethell Excerpts

Monday 13th September 2021 Lords Chamber

[Baroness Wheeler (Lab)]

On behalf of my noble friend, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, we recognise that family carers play a vital role. When we announced an additional £4.5 billion over three years for social care, it included a commitment to take steps to ensure unpaid carers have the support, advice and respite they need. We will publish a White Paper later this year with more detail. The Health and Care Bill also places a duty on integrated care boards to promote the involvement of unpaid carers.

[Baroness Wheeler (Lab)]

My Lords, the Minister has acknowledged that our 1.6 million unpaid carers are reporting high levels of fatigue and stress and are worn out and exhausted by caring during Covid-19. On average, carers have lost 25 hours a month of crucial support over the past 18 months, and 81% are providing more care. Essential daily support services for them and their loved ones are still not up and running in many areas. Was it not therefore reasonable for carers to have expected immediate funding support from the Prime Minister’s health and social care funding announcements last week? The situation is desperate and needs addressing now, not just with more kind words and another “White Paper tomorrow” promise.

[Lord Bethell (Con)]

My Lords, I do acknowledge the pressures on unpaid carers and pay tribute to the incredible contribution they have made during these very difficult 18 months. We are continuing to work with local authorities, in collaboration with ADASS and MHCLG, to support local authorities in meeting their duties, particularly in the area of respite, which the noble Baroness rightly pointed out. We have also made contributions to Carers Trust, Carers UK and to “See, Hear, Respond” services to support unpaid carers. In the long term, our commitment is to social care reform and the financial proposition that we will bring forward in the White Paper.

[Lord Lilley (Con)]

My Lords, would my noble friend confirm that he just said there would be only £1.5 billion a year going to social care from the large increase in national insurance? Can he confirm that nearly half of that will be absorbed by the need to pay for the extension of free social care to those with valuable homes? That means that nothing will be left to help domestic carers.

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[Lord Bethell (Con)]

My Lords, the maths that my noble friend has done is a little bit premature. The White Paper will come out later this year; it will spell out the precise financial arrangements, and I am looking forward to that.

[Lord Laming (CB)]

My Lords, the Minister has already indicated an understanding that many carers sacrifice a huge part of their lives in trying to care for a loved one. Many of the community support services that used to be available are no longer available. When these arrangements break down and a crisis occurs, it is understandable that the only option left is to call an ambulance, which places increased pressure on the health service. Will the Minister champion a new approach, which is this: “Protect the NHS by supporting carers”?

[Lord Bethell (Con)]

Yes, I would endorse that sentiment. That has been one of the learnings of the pandemic. It is instinctively true in any case, and the evidence base during the pandemic was quite right. They are interlinked; that is one of the reasons we are bringing forward a Health and Social Care Bill that brings both services much closer together and brings a responsibility on the ICSs to combine health and social care at the same time. Our population-wide measures will try to bring those care responsibilities much closer together, as the noble Lord suggested.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Disabled Children’s Partnership reports that parents of disabled children say that two-thirds were not able to access care at home during the pandemic. In the two years prior to the pandemic, large numbers of respite care beds for disabled children had already been shut down. Given that none of the new social care levy is targeted towards disabled children and young people, can the Minister say whether urgent funding will be provided for this vulnerable and too-often forgotten group, where unpaid carers are often on duty 24/7?

[Lord Bethell (Con)]

My Lords, I do recognise the problem: 23% of carers—1.3 million—provide care for 50 hours or more a week. That is an absolutely astonishing figure, and I pay tribute to the contribution they make. The overall contribution by carers is around £56 billion a year. We cannot undervalue that contribution in either emotional, care or financial terms. The precise allocation of funding for this new financial package is not yet confirmed. When it is, I will make sure that the reasonable points the noble Baroness made are heard clearly in the department.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in his first Answer, the Minister mentioned the Health and Care Bill and a more general duty to promote the interests of underpaid carers. Can he tell me why, at the same time, the Government are getting rid of the current provision in law of a carer’s right to an assessment when they take on a new caring role and the right to be consulted on whether they are willing and able to care? It is a crucial right of carers to have a proper assessment. Why is it being taken away?

[Lord Bethell (Con)]

My Lords, I completely agree that the carer’s assessment is the building block of our system. It is incredibly important; we do a lot of work to encourage more carers to get it. I do not know specifically about the point that the noble Lord makes on this additional component, but I would be glad to enter into correspondence with him on it. The broad principle of the importance of the carer’s assessment is one with which I wholeheartedly agree.

[Baroness Tyler of Enfield (LD)]

My Lords, research shows that, pre pandemic, 600 people a day had no choice but to leave work to manage their unpaid caring responsibilities and that, since Covid began, an additional 2.8 million workers now juggle work and unpaid care. Having access to carer’s leave would help millions of carers and support many of them to remain in work alongside their unpaid caring responsibilities. When will the Government publish their response to their consultation on carers’ leave, which closed on 3 August last year?

[Lord Bethell (Con)]

My Lords, I recognise the challenge referred to by the noble Baroness. Some 2.9 million carers are employed; that is more than half of all carers. One can only imagine the pressure that they feel trying to juggle their roles as carers and employees. The consultation has been tied up by the pandemic, but we are keen to get a response out soon. Now that we have announced this package, it makes that all the easier. I very much look forward to bringing the response to the House.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, the noble Lord, Lord Bhatia, was not present in the Chamber so all supplementary Questions have been asked. We will now move on to the next Question.

Covid-19 Update

Lord Bethell Excerpts

Thursday 9th September 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am extremely grateful for such thoughtful questions. I thank the noble Baroness, Lady Thornton, for her kind remarks: I had a very good break, and I hope that both she and the noble Baroness, Lady Brinton, did so too.

We are in a much better place than we were this time last year, but there are still serious challenges on the horizon. I am grateful for the opportunity to address some of those.

The noble Baroness, Lady Thornton, rightly alluded to the important flu vaccine rollout ahead of us. I reassure her that any issues of supply are focused very much on single suppliers, and we have a wide range of people stepping forward to supply us. We will continue an extended vaccination programme for the whole of the 2022 season, and more than 35 million people should be eligible for free seasonal flu vaccines. It will be the biggest flu vaccine rollout that we have ever done, beating, we hope, the record uptakes that we had last year. It will include a continued offer of vaccination to 50 to 64 year-olds and, for the first time, will be extended to additional cohorts in secondary schools so that those in years 7 to 11 will be offered a vaccination. The vaccination rollout is on course and we hope that it will hit all its targets.

While talking about education, I reassure the noble Baroness that asymptomatic testing in secondary schools and colleges will be continued. That includes two tests in person on return, which many have recently done, but there will be a review point at the end of September. Schools will not be responsible for contact tracing of positive cases. As with positive cases in other settings, NHS Test and Trace will work with those cases to identify close contacts. I believe that will lift a severe burden on schools and make life easier both for parents and for pupils.

On ventilation, both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, are quite right: these are important developments. But we cannot turn around a massive change in the infrastructure of our education system overnight. As autonomous institutions, it is right for providers of education to put in place their plans based on individual circumstances, including allocating their own budgets. None the less, we are putting in place special provision for ventilation in schools where there is an acute need.

To answer the noble Baroness, Lady Brinton, directly, she is right: vaccines are the primary but not the only way out of this pandemic. She will know as well as anyone our remarkable achievements in that space. The noble Baroness, Lady Thornton, asked whether we are therefore planning to have an autumn “firebreak” of lockdowns. The Government are undertaking a review to assess the country’s preparedness for autumn and winter, which will consider whether to continue or strengthen public and business guidance. We may need to take measures to help manage the virus during periods of higher risk, such as autumn. However, we will do everything we can to seek to avoid imposing restrictions that have significant economic, social and health costs. We will do it only as a last resort if absolutely necessary.

Both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, asked about children’s and young people’s vaccines. As they know, on 3 September we accepted JCVI advice on extending the list of 12 to 15 year-olds with underlying health conditions who can receive the vaccine. That is very good news. It includes children with haematological malignancies, sickle cell disease, type 1 diabetes, congenital heart disease and a number of other conditions. We are now awaiting the CMO’s assessment of the JCVI advice so far and its advice to us on whether the remaining 12 to 15 age group should also receive the vaccine. We look forward to receiving that advice.

Regarding boosters and a third vaccine, on 1 September we accepted JCVI advice on offering a third vaccine dose to individuals with severe immunosuppression. That dose is being given to bring severely immuno-suppressed individuals nearer to the same level of immunity achieved by healthy individuals in two primary doses. Again, this is very good news. Following the publication of interim advice by the JCVI in June, the Government are preparing for a potential booster vaccination programme from September, and I look forward to bringing details of that to the House at a future date.

On the mandation of vaccination in social care, we are enormously grateful for the huge amount of support among social care workers for our vaccination programme. It is true that some—a very small proportion—have not taken up the opportunity for vaccination. We hear the concerns of providers of social care, but, in the round, this has proved to be an effective programme that has delivered a huge amount of reassurance to those who live in social care and has put safety at the forefront of our efforts. That is why we are looking at a consultation on mandatory vaccination for NHS workers, following a public consultation that we recently announced. While many of those working in health and care have taken up the offer, it is crucial that this is consistent across relevant services to safeguard vulnerable people, which is why we are looking further at mandatory vaccination elsewhere.

Testing is still very much an important part of our campaign against the virus. We are supporting the testing programme, but we maintain it under review. On discharge arrangements, there has been generous financial support for discharge provisions from hospitals to schools because, as the noble Baroness, Lady Brinton, rightly pointed out, that is a very important bottleneck that has tied up a large number of hospital beds. As we go into winter, we want to have the best possible arrangements for ensuring that those hospital beds are prioritised for those who need them most.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have some supplementary questions. I am most grateful to the Minister for the update and for yet again appearing before the House. I will pose short questions about three areas.

First, on the public health messaging over asymptomatic carriers, we seem to have had a complete drop-off of mask wearing and of being distance aware. Neither of those impedes the economic viability of any business at all; they are simply social behaviours. People seem to have gone back to the most inappropriate social hugging, which is unnecessary. Yet I do not see any public health messages coming out just to maintain the control measures we had in place before. Could the Minister tell me what the plans are for that?

Secondly, does the noble Lord plan to widen the list of eligible children to ensure that those who have a family member, whether a sibling or parent, who is particularly vulnerable are offered vaccination—this would not be forced but would be an offer to them—rather than being excluded, as they are at the moment, because they themselves are not ill? They may carry quite a large emotional burden, knowing that someone at home could become very ill, despite being double vaccinated.

Thirdly, on preparing for the winter, does the Minister recognise this week’s notice from the Royal College of Emergency Medicine showing that 80% of respondents are not confident in their ability to cope safely in their departments as we go into winter, and that half of the emergency departments are reporting delays of transfer from ambulances into their departments? That compares with a quarter of such departments reporting these delays in October 2020, which would suggest that the whole backlog and silting up has got worse. Can the Minister explain what provision there is to expand bed provision, so that people who arrive in emergency departments and need admission can be moved rapidly into beds to be looked after, rather than having this backlog, which also stops ambulances going to other emergencies while they are stuck outside an emergency department?

[Lord Bethell (Con)]

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

[Baroness Donaghy (Lab)]

My Lords, perhaps I could ask the Minister two questions. My first question is the question I asked on the day we broke up in July, about whether there are plans to do booster jabs combined with flu jabs. The Minister was not certain and said he would try to let us know. Has he got more information on that?

My second question is slightly more speculative, but it is something I am very concerned about. BBC news has been extremely conscientious about keeping everybody informed about the Covid rate, the death rate and the number in hospital. Can we have an assurance that no pressure will be put on the BBC by the Government in order to bury the worrying developments that are taking place?

[Lord Bethell (Con)]

I am very grateful to the noble Baroness for asking about the co-administration of the flu and Covid vaccines. I hope very much that I got back to her. If I did not, I shall give her an update now. JCVI’s interim advice is to plan to offer Covid booster vaccines from September 2021 to prolong the protection of the vaccines provided to those who are most vulnerable to the serious effects of Covid ahead of the winter months. This would take place alongside the annual flu vaccination programme. The NHS will continue to follow the guidance given by the JCVI on the co-administration of flu and Covid vaccines—so, yes, they will be co-administered. That is an enormously effective way of delivering the vaccines, and the reach of both programmes is amplified by the other.

On the BBC, I reassure the noble Baroness that no pressure is put on it. If we had an effective pressure mechanism on the BBC, she would certainly be the first to know about it.

[Lord Paddick (LD)]

My Lords, may I take the noble Lord the Minister back to a question about Covid passports that my noble friend Lady Brinton asked and that he did not have time to answer in his first response? I understand both sides of the argument regarding Covid passes, but what I do not understand is the potential exclusion of those properly vaccinated overseas, or indeed anyone double-vaccinated outside England.

In July, the Vaccines Minister, in a Statement in the other place, said that, by the end of that month, those vaccinated overseas could have their vaccinations recorded on the NHS England system and access their Covid pass using the NHS app. Despite the Government promising that this would happen by the end of July, it is still not possible. What do these people do when they are told to self-isolate on arrival into the UK from yellow-listed countries, or when they are excluded from designated premises, if the Government bring in compulsory Covid passes for access to certain types of premises?

[Lord Bethell (Con)]

I am grateful to the noble Lord for raising the point again, and my apologies to the noble Baroness, Lady Brinton, for not addressing her point the first time around. I will just say that, from 19 July, it has been voluntary for organisations to use and implement the Covid pass under step 4. There are some essential settings where certification should not be used, and we have made that plain.

However, the Government are encouraging and supporting businesses and large events to use the Covid pass. The Government intend to make full vaccination a condition of entry to nightclubs and other venues where large crowds gather from the end of September. Work is under way to find a solution for Northern Ireland citizens who have been vaccinated in England but are registered with a GP in Northern Ireland. We are also very close to establishing data flows with the Isle of Man.

To the noble Lord’s point about those who have had their vaccinations overseas, in countries such as Norway, he is entirely right. We are working extremely hard on those processes. I have met with NHSX and NHSD to talk about this matter and I assure him that we are putting every effort into dealing with it. I wish that we had dealt with it by now. It is an extremely complex matter. The validation and verification of vaccines requires an enormous amount of bilateral and multilateral co-ordination, and the approval of different vaccines taken by different people in different locations and the record keeping by overseas countries are things that we have to consider and manage. He is right: when the Covid pass system is brought in, those who have had a vaccine overseas will need special consideration. I reassure him that we are working as hard as we can to resolve that issue.

[Lord Farmer (Con)]

My Lords, perhaps I might bring up the subject of antibodies. All the statements seem to be focused completely on vaccinations, yet there is growing evidence that those people who have had Covid and have had vaccinations are indeed almost super-immune even to variants. There was an article in today’s Telegraph about that. So my first question is, do the Government have any idea how many people have in fact had Covid? There are an awful lot of people who have not had symptoms, have been at home, have had it and have recovered, and the Government have not really been informed about it. Is there knowledge in the Government about this area and, if so, is research being done on the strength of the antibodies of those who have had Covid and is that being taken into account in policy?

[Lord Bethell (Con)]

My noble friend has had an interest in this very important area for some time, and I completely applaud his diligence on it. It is an area that I share an absolute fascination with. We know so much about the vaccines but so little about the body’s immune system. It is incredibly frustrating but it is, I am afraid to say, just one aspect of this pandemic.

To answer the specific question of how many people have had the disease, it is difficult to be precise. Unfortunately, a lot of people have had the disease and never known that they had it. The fact that they have now gone on to have a vaccine means that it is extremely difficult for us to trace whether they have had the disease, because we do it mainly through the counting of antibodies. My noble friend can look on the ONS website, which I am sure he probably has, and he will see that the Venn diagram makes it almost impossible to figure out exactly how many people have had the disease. I can, through correspondence, share with him the various modelling that we have done, but there is not a definitive answer to that question.

I wish it were true that having had the disease and the vaccine together creates some kind of super-immunity, but I am afraid that there is a subset of people who have had both the vaccine and the disease who then go on to have the disease again. I have met a few of those people; they are extremely frustrated, as you can imagine. I am afraid that it does not bode well for thinking that the vaccine presents a concrete and immutable guard against the disease. I am afraid we will be living with the thought of boosters and improvements on the vaccine for some time to come. That is emerging as something we are working on. We are doing a tremendous amount of research on this. I had a meeting earlier with the antibody team, and I reassure my noble friend that we are doing everything we can to understand it better.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I come back to the advice from the JCVI relating to 12 to 15 year-old children who do not suffer the underlying conditions it has set out. I worry about the implications of that being overruled through the process that the Ministers have set up, seeking the advice of the four Chief Medical Officers. The Minister will know that they concluded that some young people, although it would be extremely rare, could suffer from myocarditis with lifelong consequences.

I must ask about the ethical considerations here as to some young people who will be damaged as a result of that decision because 6 million adults are too stupid or ignorant to have the vaccination. That surely is where our focus should be. Could he say something about what the Government are doing? Does he agree that the integrity of the whole vaccine process, not just in relation to Covid, is at stake here? I think that the JCVI should be listened to.

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[Lord Bethell (Con)]

I violently agree with both the noble Lord’s points in spirit. If I may take them in reverse order, he is right that there are people who are not taking the vaccine, and they put the entire community at risk. Vaccination uptake among the under-30s has plateaued at around 60%. I cannot tell him exactly what will get that number up any further. That is why we look at questions such as certification and mandation. These are already in place in many European countries, including France and Italy, where they have taken advantage of certification and mandation in an extremely tough way to drive through vaccination. That example weighs heavily on our minds as we assess those two important opportunities. It is tough, and we will have important debates here in the House of Lords on both of them should they come to pass.

On children, the noble Lord is right that there are profoundly complex epidemiological and ethical issues around child vaccination. Child vaccination has been rolled out in America and in many European countries. Some European countries are looking at vaccinating those aged over three, not just those aged over 12. Why do they do that? It is because children are vectors of infection and drive the disease through their families, schools and communities. He is right that there are very rare examples, but examples none the less, where harm is done to children through the vaccine. Therefore, the assessment of that harm and weighing it up against the harm done by Covid to children, which again is extremely rare but is a statistical occurrence, and the community obligations and the damage done through the spread of the disease is something that ethicists and epidemiologists are looking at right now. We are being extremely careful about the way we do that. We are aware that it might be open to challenge. Therefore, we are dotting the “i”s and crossing the “t”s.

NHS: Nursing Workforce

Lord Bethell Excerpts

Wednesday 8th September 2021 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to retain the nursing workforce in the National Health Service following their experiences during the COVID-19 pandemic.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, we owe a huge debt of gratitude to the nurses in all parts of our healthcare system, who have done an amazing job through the pandemic. We are on track to deliver our manifesto commitment to have 50,000 more nurses by the end of the Parliament. This includes a focus on retaining nurses already working in the NHS and social care. We are taking action through the NHS People Plan to improve nurse retention by prioritising health and well-being, supporting flexible working and improving NHS workplace culture. The signs are that these efforts are paying off.

[Lord Clark of Windermere (Lab)]

My Lords, the training of these new, welcome recruits to the nursing profession will take some time. Immediate improvements will depend on the current staff, who feel battered and bruised following the intense pressure of Covid. Daily, nurses end up in tears at work and many are contemplating leaving. What specific plans—I stress “specific”—do the Government have to retain nurses to meet today’s growing problems in the NHS?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the phenomenon of burnout that the noble Lord rightly points out; the NHS people recovery taskforce, appointed to tackle exactly that problem, is very much focused on it. It works in conjunction with the NHS retention scheme and has led to the appointment of new well-being guardians, which have made a huge impact. The statistics suggest that the leaving ratio, previously at 10.3%, has now been reduced to 8.3%. That is an encouraging sign, but we have a number of other measures in place to ensure that retention remains upward at a time when, as he pointed out, nurses are under huge pressure.

[Baroness Watkins of Tavistock (CB)]

My Lords, a group of Nightingale scholars has informed me that nurses are experiencing greater levels of abuse verbally, on social media and physically, together with racism; they attribute this in part to the long waiting lists and their duties in encouraging Covid vaccinations and mask wearing. Will the Government commit to furthering zero tolerance against violence and racism towards NHS staff, which the scholars argue would aid retention significantly?

[Lord Bethell (Con)]

My Lords, the noble Baroness raises a really important point. We addressed it nearly 18 months ago, before the pandemic, when we had a crackdown on racism and abuse from patients. I would be very grateful if she could send me the details of her correspondence, and I shall look into whether we need to do more on that immediately.

[Lord Blencathra (Con)]

Why should patients with vulnerabilities and vulnerable conditions, who have obediently had their injections, risk their lives by attending hospitals or medical facilities and encountering staff who have refused vaccinations? Will the Minister make it absolutely clear that there is no place in the NHS for vaccine refuseniks either among the medical staff or among those tens of thousands of people who seem to wander around carrying files or doing non-medical work?

[Lord Bethell (Con)]

My Lords, we are looking at ways in which to take testing and other treatment out of hospitals and into the community. On my noble friend’s substantive point I say that, as he may know, we have promised to have a consultation on mandatory vaccination for healthcare. We are determined to do that in partnership with the workforce, and I look forward to updating the House on our progress.

[Lord Hendy (Lab)]

Does the Minister accept that the most important mechanism for retaining nursing staff in the NHS is by improving their wages, terms and conditions, and that the best way of doing that is by the restoration of full sectoral collective bargaining, as was the case in 2018?

[Lord Bethell (Con)]

I pay tribute to the noble Lord’s great experience and expertise in this matter. He will be aware that we have a social partnership forum, where we work extremely closely with the professions on how to improve retention. But I think that the motivation of those in public service and, in particular, in healthcare is much more complex than he describes. We have come to a 3% pay agreement with the nurses, and they have demonstrated huge support for the healthcare service during the pandemic, which suggests that it is more complex than he describes.

[Baroness Brinton (LD) [V]]

My Lords, current NHS nursing vacancies in England are now thought to be over 40,000. Nurses have recently reported concerns that a number of nursing posts at a standard that require a registered nurse or midwife are now being advertised to those not registered with the Nursing and Midwifery Council, presumably because of the shortage of nurses. What steps will the Government take to ensure that only properly qualified nurses and midwives are recruited to these posts that require registration?

[Lord Bethell (Con)]

My Lords, there are vacancies in nursing, as there always are. The vacancies at present are not hugely higher than they are normally and, in fact, we have more nurses today than we did two years ago. What I can report to the noble Baroness is that UCAS data shows 27,720 acceptances to nursing and midwifery courses in England as of 7 September. That is extremely good news; it shows the commitment of our graduates to the nursing profession and our commitment to making sure that more nurses are trained.

[Lord Dodds of Duncairn (DUP)]

My Lords, there are concerns that in some areas there are dangerously low staffing levels as a result of nurses leaving the profession. In the Belfast trust, in the first six months of this year alone, hundreds have left due to the Covid pandemic and for other reasons. Undoubtedly, that will have an impact on tackling long waiting lists. Can the Minister assure me that the money raised under the new health and social care levy and sent to the devolved Administrations, including Northern Ireland and Scotland, will actually be spent by those Administrations for those purposes, including addressing nursing shortages? As things stand at the moment, that money could be used for other purposes.

[Lord Bethell (Con)]

My Lords, there are 303,900 full- time nurses in the NHS trusts and CCGs, an increase of more than 8,900 from June 2020, so the impression that the noble Lord is giving is not, I am afraid, entirely supported by the numbers. In terms of recruitment, 2021 saw a third consecutive year of growth in the number of applicants to nursing and midwifery courses, which again is very good news. As for commitment on devolved Administrations, of course devolved does mean devolved, so I am not sure that I am in the position to make the commitment that he has sought.

[Lord Lilley (Con)]

Does my noble friend agree that, as well as retaining nurses, we need to train enough to end the scandalous reliance on poaching nurses from poor countries? The move from bursaries to loans was supposed to end the scandal of us turning away tens of thousands of applicants for British nursing courses in this country. Can he explain why last year we again turned away more than 20,000 young British people who wanted to train as nurses in this country?

[Lord Bethell (Con)]

My Lords, as my noble friend will know, the training grant of at least £5,000 per academic year per eligible student is in place, plus a further £3,000 of additional targeted funding—for example, for childcare costs and students studying special subjects. That is the kind of financial commitment that we have made to meet his concerns. On the specific point that he mentioned, I say that not everyone is suited for the nursing profession; it is a really tough job, and not everyone who wants to be a nurse can be a nurse. I am afraid that the applications that we get and the sifting that we do reflects that point.

[Baroness Thornton (Lab)]

I draw attention to my interests at Whittington Hospital in the register. Thank goodness that our nurses are incredibly resilient, but the relentless nature of working for the NHS, not just in the last year but prior to the pandemic, is now taking its toll. That includes senior and experienced nurses; there must be a worry that many could take early retirement, which is a risk to the profession. The feedback that I get, to which noble Lords have referred, is that respect and regard is less evident as the pandemic continues, and I think that is exacerbated by the debate about pay. What other initiatives is the NHS considering to deal with the fragile nature of retention—for example, housing offers, travel and the working environment—and will they be funded?

[Lord Bethell (Con)]

The points that the noble Baroness makes are entirely right, and we share exactly the same concerns. That is why we have put in place mental health support, enhanced occupational health support, expansion of the right to work flexibly across the NHS, and the promotion of equality. On the point about older nurses, two things particularly stand out: there is significant investment in leadership through the NHS Leadership Academy, and we have bespoke support for over-50s and newly qualified nurses, recognising that they are likely to be the biggest flight risk across the NHS.

[Lord Flight (Con)]

My Lords, might the Government consider upping NHS nurses’ pay rates but, at the same time, ending the practice of employing agency nurses? Frequently nurses work three days a week directly and two days a week on an agency basis, costing the NHS significantly more than full-time employee nurses.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I acknowledge my noble friend’s concerns about that point. It is a fact of life of trying to manage complex healthcare systems that you do not know necessarily on a day-to-day basis which staff you will need and exactly where you are going to need them. Therefore, we rely on flexible working arrangements, which suit some nurses who cannot make the kind of time commitments that are needed for a full-time job. There are hourly costs to that additional flexibility, but we leave it to chief executives to balance those benefits and disbenefits to achieve their objectives.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Residential Social Care: Staff

Lord Bethell Excerpts

Monday 6th September 2021 Lords Chamber

[Lord Laming]

To ask Her Majesty’s Government what steps they are taking to improve the (1) training, and (2) remuneration, of staff in social care residential services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, we are incredibly proud of our health and care staff. As a nation, we are indebted to their selfless dedication, particularly over the last 18 months. The Government fund a range of training opportunities to support the development of care staff, including through a core workforce grant of £23.47 million. However, the vast majority of care workers are employed by private sector providers, who set their pay independently of central government.

[Lord Laming (CB)]

My Lords, I am grateful, but the Minister will understand that, very often, the impression is given that the only qualification needed by these splendid staff is that of a kind heart. This is despite the fact that they are caring, day by day and hour by hour, for the people in our society with the most profound needs. Does the Minister accept that, in these circumstances, it is remarkable that the median pay for these staff is £8.12 per hour? Is it any wonder that there are 112,000 vacancies in this field? Could the Minister say whether the Government have any plans to support these staff with professional training and give them a fair salary?

[Lord Bethell (Con)]

My Lords, I endorse the noble Lord’s key point, which is that value is seen not through salary but through the skill, love and determination of our social care staff to do a fantastic job. We are extremely proud of the service that they provide. The provision of care in this country is being looked at in the spending review settlement, and the need to support the sector will be addressed in that.

[Lord Hendy (Lab)]

My Lords, does the Minister agree that the best technique for improving and regulating the wages and conditions of those engaged in the sector is through sectoral collective bargaining—a technique that was established by legislation in 1909 and abolished in 2013—namely, the wages councils. These were designed specifically for the low-paid and those less well organised in trade unions. Is it not time that there was a wages council for social care?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the insight of the noble Lord in this matter, in which I know that he is a great expert. However, he should of course remember that social care is provided through independent providers and local authorities. Social care workers are free to organise themselves as they wish, but that is not the arrangement that we have in this country.

[Baroness Brinton (LD) [V]]

Last week, three-quarters of providers in the United Kingdom Homecare Association said that recruiting social care workers is the hardest that it has ever been. In July, they warned that they faced a perfect storm of losing staff through Brexit and increased pay in retail and agriculture making their wages uncompetitive. They are at breaking point. One-third said that they are handing back some or all of their care contracts to local authorities because they cannot fulfil their contracts now—this is before they lose any unvaccinated staff—so what steps are the Government taking to urgently help the elderly in our care homes, the care homes and their staff going through this crisis?

[Lord Bethell (Con)]

My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.

[Baroness Wheeler (Lab)]

My Lords, while we await the announcement of the Prime Minister’s social care plan, after two frustrating years of non-action and delay, the continuing crisis in care homes needs to be dealt with now. With a possible 68,000 jobs now predicted to be lost in the light of the Government’s 11 November deadline for all care staff to be vaccinated, feedback from care providers shows that both care workers and the most senior and experienced staff are leaving the care workforce, with registered nursing staff constituting a much higher proportion than other care staff. What action have the Government taken to address this potential crisis in both the staffing and the management of care homes, particularly since the number of nursing jobs, for example, has decreased by 17,000, or 33%, over the past year?

[Lord Bethell (Con)]

My Lords, I do not completely recognise all of the noble Baroness’s figures, but I acknowledge that recruitment in many sectors of the economy is tough at the moment, and that is why we are putting in the measures that I mentioned to the noble Baroness, Lady Brinton. I add that we are doing an enormous amount to fund: we have put £1 billion of additional funding into social care for 2021-22, on top of the significant support provided to the sector during Covid-19 over the last year. This is money directly to address the issues that she is concerned about.

[Baroness Watkins of Tavistock (CB)]

My Lords, Plymouth’s university trust had to shut to new admissions, except for emergencies, partly because 100 beds had people in them who would have been better off at home or in residential care. This was only last week. Does the Minister agree that any CCG or local authority contracts let to provide social care in residential settings should include allowances for the cost of staff, their training, PPE, sickness and annual leave, and be funded at least at the equivalent of the local living wage, so that we can get back to a normal NHS care situation?

[Lord Bethell (Con)]

My Lords, I take on board the anecdote that the noble Baroness has just mentioned—I will look into that. I did not know about the arrangements at the Plymouth trust. On the whole, the arrangements for discharge have moved on a long way during the pandemic, and the financial arrangements for discharge have improved dramatically, so I am disturbed to hear the story that she tells, and I will definitely look into it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, a disproportionate part of the proposed rise in national insurance will fall on low-paid workers, including those in the care sector. When this announcement is made, I hope that the Minister will come forward with plans to ensure that staff in the sector get a decent living wage.

[Lord Bethell (Con)]

My Lords, the noble Lord is right that taxes have to be spread across the whole country, but I remind him that the national living wage has risen by 2.2% in the last year, which benefits everyone across the population.

[Baroness Barker (LD)]

My Lords, a number of local authorities, including Croydon, are insolvent. Have the Government or the Minister’s department made an assessment of the impact of that on the viability of care providers and the capacity of people who need social care, and are entitled to it under the Care Act, to get the services that they need?

[Lord Bethell (Con)]

My Lords, I acknowledge the pressure that local authorities are under. We do indeed keep in very close contact with local authorities that have financial pressure; I assure the noble Baroness that we will not be in a position where we breach the Care Act and that we keep very close tabs on the financial support that social care needs.

[Baroness Blower (Lab)]

My Lords, there is a recruitment and retention problem in social care and a problem of youth unemployment. Does the Minister believe that his responses provide a basis for any young person to consider a career in social care, particularly his response to my noble friend Lord Hendy?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, many young people do seek a career in social care. Many of them see it as interchangeable with work in retail and in hospitality; in fact, we have seen an enormous amount of displacement between those sectors during Covid. We have to make sure that as retail and hospitality open up, those who have moved to social care continue to stay in that setting. That is one reason we are investing in the kind of education arrangements I described.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, as the shortage of HGV drivers has led to a hike in their wages, does the inevitable increased staff crisis in care homes—effectively 40,000 to 60,000 workers will be sacked because of the illiberal mandatory vaccine for front-line workers—mean that they might get a decent amount? But seriously, does the Minister agree that any social care policy should prioritise improving working conditions and renumeration, and that this is key to the better protection of care residents and far more of a priority than obsessing about Covid at this stage in the pandemic?

[Lord Bethell (Con)]

My Lords, the average turnover rate in social care is high, as noted by many noble Lords, as it is in some other sectors, including retail and hospitality. However, turnover rates are 8.1% lower in the past year among social care workers, down from 37.2% to 29.1%, which reassures us that many have in fact found it a fulfilling career.

[Baroness Bull (CB)]

My Lords, can the Minister say what improvements have been made to staff training in light of the Out Of Sight—Who Cares? report from the Care Quality Commission, which highlighted the excessive use of restraint, seclusion and segregation in the care of people with learning disabilities and autism in residential settings?

[Lord Bethell (Con)]

We are enormously grateful for that report, which has made a huge impact. I am not sure of the specific impact of the measures the noble Baroness describes, but I would be glad to write to her.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Lord Bethell Excerpts

Thursday 22nd July 2021 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 13 May be approved.

Relevant document: 4th Report of the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I beg to move that the draft regulations be approved.

Two thirds of adults in England are overweight or living with obesity, and one in three children leave primary school overweight or obese. Obesity has huge costs to individuals, families and the economy and is one of the few modifiable risk factors for severe Covid-related illness and death. This measure is a vital part of the Government’s healthy weight strategy and will contribute meaningfully towards achieving our ambition of halving childhood obesity by 2030. The instrument that we are discussing today concerns the introduction of mandatory calorie labelling in the out-of-home sector, such as restaurants, cafés and takeaways.

Before I outline what the instrument does, I encourage noble Lords to read the Secondary Legislation Scrutiny Committee’s fourth report, which draws these regulations to the attention of the House. I extend my thanks to the committee for its scrutiny and work.

The instrument requires businesses in England with 250 or more employees to display the calorie content of non-prepacked food and drink items, except alcohol, that are sold ready for immediate consumption. Calorie information must be displayed at the customer’s point of choice, such as on menus, menu boards, online menus, and display labels. To better help customers to understand and use calorie information, businesses are also required to display a short statement referencing recommended daily calorie intake. The wording of this statement is specified in the regulations and must be displayed where it can be seen by customers when making their food choices. As well as helping people make more informed choices, transparency about the calorie content of meals will also support efforts to encourage businesses to reformulate products and reduce portion sizes.

The requirement applies to food sold in England. Scotland, Wales and Northern Ireland have been engaged throughout the consultation process, and the Scottish and Welsh Governments are considering whether to introduce similar requirements in their nations. Subject to Parliament’s approval, the regulations will come into force from 6 April 2022.

We know that people are eating out or ordering takeaways more frequently and that when people eat out, the meals they consume are less healthy. Research suggests that eating out accounts for around one-quarter of adult energy intake and that when someone dines out or eats a takeaway meal, they consume on average 200 more calories per day than if they eat food prepared at home. I know that this is the case in my life.

Research shows that portions of food or drink that people eat out or order in as takeaway meals contain on average twice as many calories as equivalent retailer or manufacturer-branded products. In a supermarket, an average pepperoni pizza is 704 calories compared to 978 calories in the out-of-home sector. I would guess that homemade pizza is less than both.

People’s access to food served in the out-of-home sector is increasing through the accelerated growth of online aggregators such as Deliveroo and Uber Eats. Kantar Worldpanel data suggests that in 2020 these types of businesses grew in value by 172% and serviced 14.5 million shoppers.

Out-of-home calorie labelling supports people to make more informed choices when eating out and encourages businesses to reformulate their food to provide lower calorie options. Research shows that popular UK chain restaurants with calorie labelling serve items with less fat and less salt than those that do not display calorie information. Calorie labelling may therefore encourage businesses to offer healthier products altogether.

Evidence from the US, where calorie labelling in out-of-home settings already has come into effect, reinforces that calorie labelling delivers a small but significant reduction in calories purchased by consumers, who noticed and used the information. Increasingly, consumers want to know how many calories are in the food and drink they buy when eating out or ordering a takeaway. Surveys indicate that nearly 80% of people think that menus should include calories for food and drink items and that 60% of people would be more likely to eat at an establishment that offers calorie labelling on its menus.

Some businesses understand this and are taking the lead by voluntarily displaying calorie information. However, we can do more to ensure that this practice becomes more widespread and consistent across the sector. Previous attempts to encourage businesses to voluntarily display calorie information through the Department of Health and Social Care’s responsibility deal have proved insufficient at driving action on the scale required to make a substantive change to our food environment. That is why we are introducing a mandatory requirement for large out-of-home food businesses.

The importance of the out-of-home food sector to local communities and to the economy is something we are acutely aware of, as is how hard our hospitality sector has been impacted by Covid-19. By requiring only large businesses to calorie label, we are ensuring that smaller businesses which will likely find the requirement more challenging to implement are not impacted. Large businesses account for 49% of all turnover in the out-of-home sector and potentially there are more significant benefits. Our impact assessment estimates that the policy will have a net benefit to the economy of £5.6 billion over the next 25 years.

In conclusion, given the scale of the obesity challenge, we must take action to make the food environment healthier and promote transparency between businesses and consumers. I encourage noble Lords to review the helpful and informative briefing provided by Diabetes UK, which I would be happy to share. Its briefing highlights the importance of this legislation to help people with, and at risk of, diabetes. By taking action to improve our nation’s health, we will be happier, fitter and more resistant to diseases such as diabetes, cancer and Covid-19. I beg to move.

--- Later in debate ---

[Lord Bethell (Con) [V]]

I thank noble Lords for their participation and thoughtful and moving contributions to today’s debate. As I have said, helping more people to achieve a healthy weight is one of the greatest public health challenges that we face as a nation.

My noble friend Lady Jenkin spoke movingly about her own battles with her weight. I completely identify with this personal struggle. I have a constant struggle to keep my own BMI in the green zone, which is about the best thing that I can personally do to live long enough to see my children grow into adults. There must be many who feel the same way.

The out-of-home food environment has an important role to play as an increasingly growing contributor to the food that we consume. People are already accustomed to seeing nutritional information on prepacked food that is typically sold in supermarkets. We want to see clear calorie information when we are eating out or getting a takeaway. This instrument plays an important role in helping to make our food environment healthier and to make healthier choices easier.

On the amendment regarding alcohol, the noble Lord, Lord Brooke, is right that excessive alcohol consumption is by far the biggest risk factor attributable to early mortality, ill health and disability among 15 to 49 year-olds in the UK. It is estimated that each week 3.4 million adults consume an additional day’s worth of calories just from alcohol. The noble Baroness, Lady Finlay, is entirely right that the public are utterly unaware of the calorie content of alcohol. Like the noble Baroness, Lady Bennett, I like the occasional drink, but surveys show that up to 80% of adults have a hazy understanding of the calorie content of common drinks, and I confess that I am probably one of them.

Transparency is key to support consumers to make better choices. However, nutrition labelling requirements are currently voluntary for alcoholic drinks; the example of a bottle of alcohol-free Becks makes that point pretty well. I accept that this makes it more challenging for businesses to list calorie information for alcoholic drinks on their menus. I give the noble Lord, Lord Brooke, the noble Baroness, Lady Finlay, and all those who have expressed concern about the issue this commitment: the Government will be consulting shortly on whether calorie information should be mandated on prepacked alcohol and alcohol served in pubs and restaurants. Covid-19 makes it more important than ever to support the nation to achieve a healthier weight, and the Government are taking action to help people to lead healthier lives.

On the amendment in the name of the noble Baroness, Lady Bull, I completely understand the concerns about the impact of these regulations on those living with eating disorders. In particular, the noble Baronesses, Lady Parminter and Lady Greengross, and my noble friend Lady Wheatcroft spoke movingly, with highly relevant personal testimony. I reassure the noble Baroness, Lady Bull, that these experiences and evidence-based reservations make Ministers stop and think very carefully about the regulations. They reminded me of the experiences of my loved ones who have struggled with eating disorders, and of my friends whose parents have struggled with the heart-breaking battle of loving children who are dogged by these torments. That is why we want to ensure that people have access to the right mental health support in the right place and at the right time.

To the noble Baronesses, Lady Walmsley and Lady Greengross, and my noble friend Lord Moynihan, I make it clear that improving eating disorder services is a key priority for the Government and a vital part of our work to improve mental health services. We recognise that eating disorders are a serious, life- threatening condition. With that in mind, we have to be careful to consider the views of mental health charities and experts, and we did so as we developed our regulations.

We have consulted widely throughout the development of the policy. We heard from key medical groups, including the British Medical Association and the Royal College of Paediatrics and Child Health, which highlighted the importance of tackling obesity and support for the introduction of mandatory calorie labelling in the out-of-home sector. We also studied carefully research in the UK that found that menu labelling is associated with serving items with less fat and less salt in popular UK chain restaurants compared with those that do not display calorie information.

I say in response to my noble friend Lady Fall that research suggests that mandatory enforcement of calorie labelling will encourage reformulation.

We have also engaged with and listened to feedback from those representing the views of people living with eating disorders, including the eating disorder charity, Beat. In response, we have put in reasonable adjustments to help mitigate any unintended consequences.

I therefore reassure the noble Baroness, Lady Bull, with the following commitments. First, following feedback on our consultation, we have decided to exempt food that is provided in schools and other educational establishments due to some concerns about displaying calorie information in school settings. Secondly, as the noble Baroness, Lady Walmsley, has noted, we have also included a provision in the regulations which permits businesses to provide a menu without calorie labelling at the request of the consumer. I would welcome any suggestions from the noble Baroness or any other noble Lords on how this can be done in the most sensitive and effective way possible as we draft the detailed guidelines.

Regarding those guidelines and regulations, I reassure the noble Lord, Lord Berkeley, that we are working closely with business and local authorities on guidance to support implementation of the policy to ensure that it can be implemented smoothly, including in relation to the practical dilemmas he rightly highlighted such as the labelling of irregularly shaped fish and chips.

My third reassurance to the noble Baroness, Lady Bull, is that we will continue to evaluate the impact of calorie labelling across the population, including on people with disorders. I reassure the noble Baroness, Lady Brinton, that, as required under the regulations, the Secretary of State will review the regulations at between three and five years. I make the commitment now that this will be done with the full engagement of all those concerned about this important but delicate regulation.

The noble Baroness, Lady Bull, is right: every public health measure is a trade-off. Obesity is a massive challenge we face as a nation. We cannot duck it, but this does not diminish the Government’s determination to ensure that people living with eating disorders have access to the support they need.

In response to the question about the evidence available to support this policy, I highlight that the Government’s impact assessment estimates that 174 billion fewer calories will be consumed in England per year as a result of this policy.

Consumption of fast food and takeaways is particularly prevalent among families. Evidence from 2016 showed that 68% of households with children under 16 had eaten takeaways in the previous month, compared with only 49% of adult-only households. We have a role and a responsibility to support parents, particularly in the most deprived families and areas, to help their children have the best start in life.

The noble Baroness, Lady Greengross, is right to emphasise that transparency in our food environment and giving people information they need about their food and drink purchases is important in delivering our ambition to halve childhood obesity by 2030. There is a lot to gain by helping more people to be the right weight, and it is vital for us to work together to achieve this. I commend the regulations to the House.

NHS Update

Lord Bethell Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.


Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”


Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I join the noble Baronesses, Lady Thornton and Lady Brinton, in thanking my noble friend Lady Penn for her hard work over the last 18 months and wishing her well in her pregnancy. She looked absolutely fantastic as she left, and our hopes and good wishes are with her.

I also thank the usual channels, the House of Lords staff and the Speaker’s office for all their contributions to the virtual House and for keeping the business of the House going during this awful pandemic. There has been an enormous amount of traffic from the Department of Health—more than 50 Statements, 2 Acts and hundreds of regulations. I thank all noble Lords for their challenge, their scrutiny and their patience during this difficult time.

The pay review body has given us its recommendations, and we have accepted them. I thank it for its work and insight. I reassure the noble Baroness, Lady Thornton, that the Office of Manpower Economics will publish its analysis online shortly. We are extremely pleased that we can follow the guidance of the pay review body. Junior doctors have their own separate framework, worth 8.2% over four years. They are working from that framework today.

On the funding of the pay review, as noble Lords know, we gave the NHS a historic £33.9 billion settlement in 2018 and have provided £92 billion to support front-line health services throughout the pandemic. The pay uplift will be funded from within that budget, but we are very clear that this will not impact funding already earmarked for the NHS front line. We will continue to make sure that the NHS has everything it needs to continue to support its staff and provide excellent care, throughout the pandemic and beyond. That is why we accepted the PRB’s recommendations in full and provided NHS workers in scope with the pay rise.

On the question from the noble Baroness, Lady Brinton, on safeguards in September, I cannot make any guarantees but I definitely hope not. We very much hope that we are in the final stages of this pandemic, as the impact of the vaccine is being felt, bringing down the R number and saving those who are infected from hospitalisation, severe disease and worse.

The noble Baroness, Lady Thornton, talked about filtration for schools, and I noted her question on this yesterday. I said that we had been looking at it. I am not aware that the results of that analysis have come through yet. To be honest, I am wary of investing too much in unproven technologies. The two things that have been proven to work are isolation and vaccination; we are backing those two measures most of all. However, I accept her point about the importance of ventilation and will continue to look at it.

Likewise, the JCVI is looking very carefully at vaccination for children. We are working with international partners to get to the bottom of it. At the moment, we have a clear read-out—we will move—but our priority is providing either third shots or variant booster shots in the autumn to the most vulnerable. That is where our priorities are at the moment.

The noble Baroness, Lady Brinton, asked about social care. I note the Government’s statement on that; we will bring reform recommendations in the autumn. On her point about the autism strategy, I also pay tribute to the contribution of Cheryl Gillan, who worked so hard in this area and whose impact is still being felt.

I think the noble Baroness, Lady Brinton, overlooks some of the really good work in this strategy. There is £74 million of funding for a number of high-priority projects, which have been designed in collaboration with stakeholders from the community. I guide her to the implementation plan that accompanies the strategy, which has detailed recommendations on a six-point implementation matrix that has grit and traction. I would be very grateful for her feedback on that.

I pay tribute to parent supporters; the noble Baroness, Lady Brinton, is entirely right that they often bear the brunt of care and are often best placed to care for and support those with autism. I remind her that we have provided £31 million through the mental health and well-being recovery action plan specifically for the parents of those with autism, recognising how the pandemic was hitting that group in particular.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

[Lord Lansley (Con)]

My Lords, following our debates on the Medicines and Medical Devices Act earlier this year on an innovative medicines fund, the announcement in this Statement of a ring-fenced £340 million budget for innovative medicines is very welcome. When will those become available, so that clinicians and patients can access this funding? Given that it now takes us beyond cancer drugs and innovations, will there be a focus on those diseases for which there has been no effective treatment?

[Lord Bethell (Con) [V]]

My Lords, I am grateful to my noble friend for highlighting this important development. The cancer drugs fund was a great success, and we are building on it with a substantial investment. The new fund will support patients with any conditions, including those with rare and genetic diseases. Dementia is one area where we are extremely interested in looking at investing further, and I hope that this would be captured, but we are waiting for recommendations from NICE and the data that it will provide before we set the right prioritisations. In terms of the date, I do not have that at my fingertips, but I would be glad to write to my noble friend with the details.

[Baroness Hollins (CB)]

My Lords, the strategy promises millions to prevent mental health crises for autistic people and to help people detained in hospital back into the community. The Written Ministerial Statement responding to my 2020 independent report about people with learning disabilities and autistic people detained in long-term segregation was laid in the other place after the Minister’s Statement had finished. My report emphasised the urgency of these strategy promises. Will the noble Lord commit to meeting me, with the Secretary of State, to discuss the full implementation of my recommendations?

[Lord Bethell (Con) [V]]

My Lords, I am enormously grateful to the noble Baroness for her hard work in this area. We are taking a range of actions to drive further, faster progress on reducing the number of autistic people and those with learning disabilities in in-patient mental health settings, including robust action by the CQC, work on our new cross-government “building the right support” delivery board, and reform of the Mental Health Act. I would be very glad to meet the noble Baroness and her colleagues to discuss these and other measures in more detail.

[Lord McNicol of West Kilbride (Lab)]

I declare my interests as set out in the register. My Lords, Ministers rightly come to these Chambers and praise NHS staff for all they have done throughout the pandemic, yet a third of NHS staff are considering leaving their job. Vacancies are endemic and, to top that, we have a looming summer crisis. For an average nurse, 3% is equivalent to £15.40 a week. Inflation removes £11.58 of that; so, for all the Minister’s kind words, in real terms that is a pay rise of £3.82 a week, or 55p a day, and less than half of that for a newly qualified nurse. Does the Minister think this is fair, and what does he think the nurses should do with their 55p a day?

[Lord Bethell (Con) [V]]

My Lords, I am also enormously grateful for the contribution of NHS staff at all levels and from all parts of the United Kingdom. This pay settlement is based on the recommendations of the pay review body. We said that that was the mechanism we would follow, and we are following it; in that respect, we are doing what we said we would. I reassure the House that recruitment to the NHS is extremely strong. We are hitting our targets on the recruitment of 50,000 nurses and our targets for GP trainees and in other parts of the NHS.

[Lord Brooke of Alverthorpe (Lab) [V]]

My Lords, I welcome the Minister’s offer to meet the noble Baroness, Lady Hollins, to discuss her devastating report. We should be ashamed to see the way some of our people with learning disabilities and our autistic young people have been treated. I would like to know whether the Government’s action plan can give some realistic dates on when there is likely to be proper service and support given within local communities and within homes that should be created for them.

Secondly, on Covid generally, I have been double-jabbed with Pfizer, so it is unlikely that I will go into hospital, but I have Covid. I would like to pick up on the question from the noble Baroness, Lady Brinton—what are the figures for the number of people who have had their vaccinations but are now starting to suffer from Covid? This is not flu; it is quite different from flu. You get the jab for the flu and you stay clear of it. With this, you get the jabs but you can get it just the same—and I have been suffering. Why are the Government giving mixed messages that people are now going back to normal? This is just not the case. We are sending out mixed messages and giving the impression that we have this “freedom day”. Yes, there will be freedom, but there will be freedom to spread on a scale that we have not experienced latterly. So I hope the Government will be cautious with the mixed messages they have been issuing and they will underline that having the double jab does not necessarily mean that people are clear of catching the disease.

[Lord Bethell (Con) [V]]

The noble Lord has my profound commiserations. It is an extremely tough and nasty disease, as he rightly points out. Even for those who have had two jabs, if they get the disease it can still be a really horrible experience, which he has at this moment.

He is not quite right, though, on the mixed messages. We have been crystal clear from the very beginning, even before the first vaccine arrived, that the vaccination was not going to be a panacea in itself. It will not prevent all people from getting all Covid diseases for all time, immediately. These things are incremental. The societal impact of the vaccine is to drive down the infection rate to the point that R is below one; that is the objective. But, in the meantime, those who have had the vaccine not only remain infectious but can be heavily symptomatic, and I am very sorry for the position he is in. Incidentally, that is also true of the flu vaccine; it is not a 100% vaccine, but it does an enormous amount to break the chain of transmission and to reduce the spread of flu on exactly the same basis.

[Lord Haselhurst (Con) [V]]

My Lords, if more people anxious to show their support for our magnificent NHS staff would see being vaccinated and wearing masks in crowded places as a smart move on their own part, would they not also see it, crucially, as sending a signal of support to all those in the NHS?

[Lord Bethell (Con) [V]]

My Lords, my noble friend hits the nail on the head. Not only is getting vaccinated and wearing a mask in the right settings a sign of support for NHS staff, it is a sign of support for the whole of society. We depend on each other during this pandemic. When someone catches the disease asymptomatically and spreads it to someone else, they hurt all of us. We all have to be careful to take our tests when we are going into a position of risk, to wear our masks when we are close together and, of course, now that the vaccine is available to all over 18 year-olds, to ensure that all the people we can persuade have taken two jabs.

[Lord Dubs (Lab) [V]]

My Lords, the Minister has on more than one occasion in the last few minutes been asked about the position of care workers. They have been totally left out of the pay settlement. They are working on extremely low wages. Does the Minister not agree that something must be done to help care workers, whether in domiciliary care or in care homes, to have a decent wage and not be treated as the country cousins in this whole thing?

[Lord Bethell (Con) [V]]

The noble Lord is right: we are concerned about the pay, conditions, career prospects and retention of care workers. I have spoken about this in detail in debates on social care, and I share the sentiments of the noble Lord. When we come to social care reform, the correct provisions for social care workers will form an intrinsic part of those reforms. I do not wish to be obtuse, but this is about the NHS. The NHS is a direct employment body, whereas social care has a different employment system and is therefore not covered by this particular settlement.

[Lord Balfe (Con)]

My Lords, while I am sure that we appreciate the work done by NHS staff, I remind noble Lords that it was NHS staff in the Radcliffe Infirmary in Oxford who put a “Do not resuscitate” notice on my good friend Caroline Jackson’s bed without her knowledge—she found out about it only much later. I have asked the Minister about this. The last Written Answer I got said that a report would be produced “in due course”. Can the Minister ensure that these notices are rigorously reviewed before they are put on people’s beds and certainly not, as in the case of Mrs Jackson, put on the bed without her or her husband or anyone close to her knowing that it had been put there? Not all NHS staff are perfect.

[Lord Bethell (Con) [V]]

As my noble friend will know, I know Dr Jackson extremely well from the old days and heard her story with great regret. I took the story back to the department and played it into the system, as I told him I would do. A report is being drafted and I can reassure my noble friend that it is being taken seriously. The clarification of guidelines has been sent to all wards and there has been additional training for staff put in the position of needing to consider and engage with loved ones on this issue. However, may I push back against my noble friend? It is not right to try to generalise about staff on this point. I have the highest regard for NHS staff. In the very large majority of cases, they have worked extremely well in difficult circumstances in these situations and they are owed our respect for that.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the Minister made that point very well. I declare an interest as a member of the board of the GMC because I want to ask him about workforce strategy. Clause 33 of the Health and Care Bill sets out a duty on the Secretary of State to publish

“at least once every five years … a report describing the system in place for assessing and meeting the workforce needs of the health service”.

The Minister will be aware that a number of NHS organisations say that this is not going far enough and that what is needed is the development of regular, public, annually updated long-term workforce projections so that the health service can meet the undoubted challenges that lie ahead. Is the Minister prepared to consider this?

[Lord Bethell (Con) [V]]

My Lords, I have heard the noble Lord on this point two or three times and he makes the argument extremely well and persuasively. As he knows, a huge budget of the NHS goes on the workforce; essentially, the NHS is a mobilised healthcare workforce. It is intrinsic to the success of the NHS that we manage our workforce correctly. There are substantial workforce transformation programmes in place at the moment, including the People Plan, and a huge recruitment drive is going on, including the creation of a much clearer employer brand, which has landed very well among the workforce generally. However, I take the noble Lord’s point. I am not the workforce Minister but I will take it back to my colleague Helen Whateley in the department and ask her for her consideration.

[Lord Cormack (Con)]

My Lords, I hope that my noble friend, who deserves a real holiday, will accept that it would have been far better and more honest had the pay award been made in an Oral rather than a Written Statement. We all send our warm wishes to the noble Lord, Lord Brooke of Alverthorpe, for a speedy recovery. However, does not his story underline the need for clarity in Oral Statements? I put to my noble friend last week the idea of statements in all the newspapers which would be clear, cohesive and coherent. Is that idea still being followed up, as he promised it would be?

[Lord Bethell (Con) [V]]

My Lords, I have followed it up. We have invested a huge amount in our statements. This takes up a large bandwidth for our broadcasters and of the advertising budget of the Cabinet Office and the department—we could not have spent any more money on advertising than we have done to try to get our messages across. However, some of these messages are difficult to understand and sometimes difficult to accept. We all wish that the vaccine was as clear-cut and emphatic as are the vaccines for polio or the other blockbuster vaccines. However, as the noble Lord, Lord Brooke, just described, and as poor old Sajid Javid is currently feeling, two jabs do not guarantee that you will not be infected and infectious. However, neither of them is in hospital and neither of them is suffering from severe disease. The message is nuanced: the vaccines work, will reduce transmission and will help us to get this country out of the disease, but people will still have to proceed with caution, isolate when they are in contact with those with the disease and protect themselves from transmission with masks and social distancing.

[Baroness Uddin (Non-Afl)]

My Lords, I express my gratitude to each and every one in the House for their care and attention these past difficult months. To echo the noble Lord, Lord Balfe, I, too, have been messaged on hundreds of occasions over the last few months on the issue of DNR, on which I will ask a question. In the light of the reports of 39,000 deaths in care homes and the fact that 59% of all those who perished had a disability or autism, when will the Government commence the national inquiry so that those who lost their loved ones can be reassured that no deaths occurred unnecessarily due to government policy decisions and lack of proper and adequate safeguards for all residents in care homes and their well-being and that DNR was not applied disproportionately to people with disability and autism without sufficient oversight, given the incredible pressures on the NHS during these months?

[Lord Bethell (Con) [V]]

My Lords, we will be accountable for the use of DNR and it is right that the noble Baroness’s specific question should be asked: were any groups disproportionately at the wrong end of this? She is right to ask the question. I cannot give her a precise date for the inquiry, but I have given absolutely cast-iron reassurances that it will happen. I am very tired, as is everyone else, and the thought of starting an inquiry today while preparing for the winter is not one that will help our productivity or help to save lives in the difficult time that we have ahead. The right time for the inquiry is probably when the pandemic is truly behind us.

[Baroness Neville-Rolfe (Con)]

My Lords, the NHS is highly regarded by most people because it is available to all for free. But, as the Statement rightly recognises, despite record investment, it faces major challenges. In particular, survival rates for many cancers trail those in comparable countries. How do we secure the necessary improvements in the NHS, especially at a time when it faces record waiting times?

[Lord Bethell (Con) [V]]

My noble friend gives me an opportunity to raise one of my main ambitions for the health service, which is clearly outlined in the life sciences vision. She is right: we catch too much cancer at stage 3 or 4, when there is sometimes not much that we can do, and anything that we do will be very expensive and make only marginal differences. That is not the same in all countries and it is not good enough in this country. That is why we need to invest in diagnostics and preventive medicine. We need to reweight our health system away from clinical interventions on lumps and bumps at a very late stage. We need to interact with patients at a much earlier stage of their disease. Only in that way will we be able to afford the healthcare system that this country deserves and to give people longer, better lives.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, as we have reached 2 pm there is no need to adjourn the House, but I will arrange a short pause to allow the relevant people to be in their places for the next item.

Animal Diseases: Future Pandemics

Lord Bethell Excerpts

Wednesday 21st July 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, zoonotic diseases comprise approximately 75% of all newly identified infectious diseases and 60% of existing ones. The UK has world-leading “one health” expertise already enhancing the detection, investigation and management of zoonotic diseases. We must continue to weave this approach into the fabric of domestic and global architecture. Through our G7 presidency and ambitious initiatives, such as the centre for pandemic preparedness, we will further strengthen our “one health” capability.

[Lord Trees (CB)]

I thank the Minister for his Answer. I shall press him for more specifics. Given the huge cost of zoonotic pandemics—Covid-19 has been estimated to cost the UK £340 billion—what plans have Her Majesty’s Government been considering to improve animal health, public health and environmental health systems which are critical in the prevention of spillover infections from animals to humans in the UK and abroad?

[Lord Bethell (Con) [V]]

My Lords, there is a very large number of initiatives. I emphasise our international efforts to reverse the underlying causes of spillover infections from animals to humans, including biodiversity loss and the risk from the illegal wildlife trade. Using the UK’s G7 presidency, we have committed to doing more by establishing the International Zoonoses Community of Experts, by creating the centre for pandemic preparedness and conducting a one health intelligence scoping study to ensure that the systems work better together to identify future threats.

[Baroness Blackwood of North Oxford (Con)]

My Lords, in 2016 a woman in rural Thailand spotted a cow frothing at the mouth. She snapped a few photos, reported it on the “one health” disease detection app and local authorities stepped in. They limited the spread of foot and mouth to just three cows, averting millions in potential losses. This app is now expanding across Asia and Africa, supported by Dame Sally Davies’s Trinity Challenge. This demonstrates that ever more global health data by itself is just not enough; it is deriving actionable insights from that data that matters, and that needs dedicated analytics tech at scale. What steps is the Minister taking to find and scale the “one health” surveillance tech that we need to prevent future pathogenic risk?

[Lord Bethell (Con) [V]]

My Lords, my noble friend puts it extremely well. It is exactly that kind of intervention at the front line that can nip infections in the bud, but it is only through international collaboration that we can really tackle the threat of zoonotic infection. The concept of zoonotic tech is not one that I had previously come across, but I will take it away from this debate and have a good look at what more we could do to support it.

[Lord Patel (CB) [V]]

My Lords, one of the key “one health” projects initiated by government has been the target of reducing the prophylactic use of antibiotics in farm animals to help reduce the incidence of antibiotic resistance, thereby helping to treat zoonotic diseases in humans. The Government set targets in 2017 on the use of antibiotics in animals over the next three years. What progress has there been? What other plans are going forward, as the 2017 project has now ended?

[Lord Bethell (Con) [V]]

The noble Lord identifies the threat extremely well indeed. The Department of Health works extremely closely with Defra on this exact point. I pay tribute to both the farming community here in the UK and officials at Defra for their work to encourage farmers to stand back from prophylactic use of antibiotics.

[Baroness Bryan of Partick (Lab) [V]]

My Lords, one of the most important lessons about “one health” from Covid-19 is that we must share more than just surplus vaccines; we must share the capacity to make vaccine. Can the Minister explain why the Government are resisting even a temporary TRIPS waiver when so many world leaders support it?

[Lord Bethell (Con) [V]]

My Lords, the noble Baroness is right that we need to massively increase international capacity for vaccine production. The Government are working on a vaccine strategy that will include ideas for doing that. A TRIPS waiver is something we have looked carefully at. It is our strong view that this Government support intellectual property, because it is only through our commitment to intellectual property that we can encourage the kind of massive investment by the private sector necessary to develop vaccines in the first place. For that reason, we remain hesitant about supporting a TRIPS waiver policy.

[Baroness Brinton (LD) [V]]

My Lords, Professor Sir Jeremy Farrar says in his new book that viruses do not change how they transmit between humans and animals, but humanity has become much more mobile. He deplores the pandemic nationalism evident over the last year, saying:

“Only the virus benefits from a pivot towards myopic nationalism because that will keep it circulating for longer. A divided world is a diseased world.”


I thank the Minister for saying what the Government plan to do through their chairmanship of the G7, but can he please confirm the timetable for the delivery of the “one health” approach, including its funding?

[Lord Bethell (Con) [V]]

My Lords, the “one health” approach is moving through the G7 process at the moment. I am not sure whether a precise timetable exists. I am happy to check to see whether dates are available, and I will write to the noble Baroness accordingly.

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the health and scientific world has, not surprisingly, been focused on the pandemic. The FAIRR report published today and previous reports in this area show what a threat to world health there is from antimicrobial resistance. The question is: how much of a priority is this in the Government’s work? I think that is what most speakers have asked. How much money is the department investing in this area this year and in the next five years?

--- Later in debate ---

[Lord Bethell (Con) [V]]

I assure the noble Baroness that it is a massive priority. The threats from both zoonotic transmission and antimicrobial resistance are areas in which Britain has previously shown great international leadership. Through our G7 chairmanship we will continue to take up that mantle. I pay particular tribute to the work of Dame Sally Davies on antimicrobial resistance. She has done an enormous amount, particularly through the Trinity Challenge, to raise awareness and bring together Governments, industry and academia on this matter. I do not have the precise budget to hand, but I will be glad to write to the noble Baroness with any details that are available.

[Lord Flight (Con)]

What proportion of infectious diseases in people do the Government estimate to originate in animals? What should be the result of doctors and vets adopting a “one health” approach?

[Lord Bethell (Con) [V]]

It is the case that 75% of all newly infectious diseases come from animals. Diseases such as HIV began when transmitted from an animal to a person. The Ebola, Zika, SARS, MERS and SARS-CoV-2 viruses are all examples of recent zoonoses. As the noble Baroness, Lady Brinton, pointed out, the changes in human behaviour are only going to accelerate this. That is why we are so committed to the zoonotic agenda and why vets and those who work with farm animals need to have raised awareness of this threat.

[Baroness Young of Old Scone (Lab) [V]]

My Lords, I declare my interest as chair of the Royal Veterinary College. The Minister has stated the Government’s commitment to “one health”, but ODA cuts have slashed by two-thirds the funding of the UK’s single biggest “one health” programme, the One Health Poultry Hub led by the RVC, which tracks and fights disease emergence from poultry in Asia to combat this vector for a human health pandemic that will inevitably occur. How does the Minister intend to fulfil his commitment to “one health”, and the PM’s at the UN and G7 levels, in light of the Chancellor’s Statement last week? The criteria for restoring the ODA cut show that that will not happen for several years.

[Lord Bethell (Con) [V]]

My Lords, our contributions to “one health” are partly through our collaborations with foreign Governments, but they also include Defra’s work here in the UK and the contribution of British scientists, such as through the Trinity Challenge that I mentioned. The noble Baroness is right that this is not cost free, and we have to explain the value of this work to the taxpayer. That explanation is easier after a pandemic as massive as the one we have had, but we need to look closely at the value-for-money judgments needed before we make the necessary investments in this agenda.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed. We now come to the third Oral Question.

Covid-19

Lord Bethell Excerpts

Wednesday 21st July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.

The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.

The phrase in the Statement:

“We are cautiously easing restrictions”


is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.

That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.

The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.

The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.

This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?

The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.

With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I am enormously grateful for the thoughtful and challenging questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will start by using a couple of their specific questions to illustrate, as clearly as I can, the strategy behind our approach and the challenges and limitations in what government can and cannot do.

When it comes to the app, this situation illustrates the difficulties of leaving an epidemic. I remember well the CMO talking about what happens to a country when it enters an epidemic; at the beginning of last year, he gave us an introduction and said how difficult it was when you are trying to make that transition. The challenge is of having a partially vaccinated population that has huge pressures to get on with life, while at the same this infection leaves many largely untouched by the virus—in fact, the largest proportion of people. That is exactly the kind of dilemma we are wrestling with.

With the app and the Government’s position on whether you have to isolate when you get pinged, isolation remains the most important action that people can take to stop the spread of the virus. It breaks the chain of transmission. There is no single better measure for breaking the spread of the virus than isolation, so it is argued that it is crucial for people to isolate when told to do so, either by test and trace or by the app. I can confirm that the Government’s advice is to isolate if you are pinged by the app although, as I have said previously, this is not captured in law.

Both noble Baronesses asked about policy on schools and why we emphasise Covid vaccination over LFDs for entry into venues. Those questions give me an opportunity, I hope, to be really clear about the strategy. It is to vaccinate a sufficient proportion of the country that the virus cannot spread so easily, and that R is brought below 1. When we have that moment, we can be more confident that the impact of the virus on hospitalisations, severe illness and worse will be brought under control. At the rates at which we are vaccinating, we are hopeful that we can reach that stage relatively soon.

There is no other plan; there is no way of beating the virus other than ensuring that the vaccination deployment is as effective as possible. That is why we are looking at ways to bring young people and those who are reluctant onside, by engaging them in dialogue, answering their questions and emphasising through our measures the critical importance of vaccination, particularly when sharing space with others in your community.

On vaccinating children, healthy children are at a very low risk from Covid-19, with their risk of death being around one in 2.5 million. No previously healthy child in the UK under the age of 15 has died from the pandemic in the UK, and admissions to hospitals or intensive care are very rare. That is why we are taking a cautious approach in this area. The JCVI will keep this advice under review as more safety and effectiveness information becomes available on the use of vaccines in children; for example, regarding reports of myocarditis as an adverse event following vaccination with Pfizer. However, we will be extremely energetic in looking at all avenues in this area.

We are also looking at booster shots. Following the publication of interim advice by the JCVI, the Government are preparing for a potential booster vaccination programme from September. The noble Baroness, Lady Brinton, asked what the state of the country will be in the autumn. That will in large part depend on the flu vaccine and on the Covid vaccine, which can be taken at the same time. We are working closely with GPs to ensure that that rollout is as effective as possible, because the resilience of the NHS depends enormously on the success of our dual vaccine rollout.

Lastly, the noble Baroness, Lady Thornton, spoke about the importance of keeping life moving. I do not know that phrase but I know that there is a huge backlog in the NHS. There are other profound impacts of our social restrictions and our lockdown measures on the health of the nation, the economy and our society. We cannot continue in this way for ever. There is value in trying to open up our economy and giving individuals the information to be able to make decisions for themselves. That is the inflection point we are at now. I have enormous sympathy for those looking for information on the best approach but I hope the direction of travel is crystal clear.

[Lord McNicol of West Kilbride (Lab)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions.

[Baroness Wheatcroft (CB)]

My Lords, I too send my best wishes to the noble Baroness, Lady Penn. I echo the concerns of the noble Baronesses, Lady Thornton and Lady Brinton, over the contradictions over nightclubs and pubs and when we are going to insist on double vaccinations. Why not now? Why wait until September?

It is the contradictions in government policy that continue to cause concern. It is good to know that we are going to insist on vaccination for those working in care homes but why not across the NHS? Surely there is good sense in doing that.

We have lessons to learn from the treatment of Covid. We need to learn them as quickly as possible before the next emergency strikes. Sir Jeremy Farrar, the chief executive of Wellcome and a very eminent member of SAGE, has been coruscating about the failure to launch an inquiry now and to wait until March. Can the Minister explain why, when different people would be involved in conducting an inquiry, it cannot get under way immediately and report back as quickly as possible?

[Lord Bethell (Con) [V]]

My Lords, I have complete sympathy with the noble Baroness about the fast-changing nature of our response to this pandemic. However, as I have said from these Benches before, it is the virus that chops and changes and delivers us surprises. Who would have expected two or three months ago that the delta variant would have hit us as hard as it did?

We are trying to be agile and to adapt to changing circumstances. The guidelines on nightclubs and pubs will be published and when they are published, they will, I hope, be clear. The arrangements for September are being arranged right now. On mandatory vaccination in the NHS—which I think is what the noble Baroness inquired about—we have signalled our intention to consult on mandatory vaccination across the healthcare service. I hope that I will be able to share further details on that with the House at a future date.

In terms of an inquiry, of course I hear Sir Jeremy Farrar. However, I and many others are already working all the hours that God gives us on responding to this pandemic. There is no extra bandwidth for dealing with an inquiry. We are doing our best and we will look back and learn the lessons when the moment is right.

[Lord Herbert of South Downs (Con) [V]]

My Lords, given the growing number of people now being pinged and required to isolate, would it not make sense now to extend the sensible and welcome provision for critical workers so that those who have been doubled jabbed and then taken negative PCR tests need not isolate? I appreciate my noble friend’s point about breaking the chain of transmission but there is a danger that people will quite reasonably not see isolation as a proportionate requirement when they have been double vaccinated and tested. As well as the growing impact on businesses and public sector organisations of losing staff for up to 10 days, is there not also a need to maintain public confidence in the NHS Covid app? That is clearly now a serious concern.

[Lord Bethell (Con) [V]]

I hear loud and clear the concerns that members of industry and critical services have about isolation of the workforce and the impact that is having on supply chains and the provision of services. However, I cannot hide from my noble friend that the infection rates are higher. It is important that people who have been close to someone who is infected isolate themselves. If they do not, infection rates will go higher still, and if we have sufficiently high numbers of infections, although the vaccines are incredibly effective, that will roll into hospitalisations, severe disease and worse. This is a moment for holding steady and keeping the line. I am hopeful that this moment of acute discomfort for industry and services will pass soon.

[Baroness Donaghy (Lab) [V]]

My Lords, as the noble Baroness, Lady Wheatcroft, said, every contradiction by a Minister not only confuses but encourages opt-out. If even those of us who follow these issues closely are totally confused by what is happening and what the Government’s intentions are, it is hardly surprising that people are going to sit down and make their own decisions, rightly or wrongly.

My noble friend Lady Thornton asked what happens if the rates of vaccination fall. Are there any figures to support that and are there any plans to increase the urgency of vaccines? What is the situation for those involved in social care who are not in care homes but who go visiting from home to home? Will they be made to have double vaccines? Who will be the monitor? Will it be local authorities?

Finally, on the booster jab and the combination with the flu jab, the Minister was fairly definite about this and said that they can be done at the same time. Will they be done at the same time? Also, is a programme of vaccinations for flu and Covid combined already set out, or is that part of a future plan?

[Lord Bethell (Con) [V]]

My Lords, the take-up of vaccine will at some point begin to tail off among some demographics. We are redoubling our efforts with our marketing and the availability of the vaccine, particularly among younger groups. The introduction of domestic certification for major events and pubs and clubs, if that is brought about, will create a strong incentive. These are the kinds of measures that we are putting in place to see through the strategy which, as I said at the beginning, is to get the vaccination levels to such a rate that R is below 1.

In terms of social care, as I mentioned earlier, we are looking to consult on domiciliary care and other forms of the healthcare system. On booster jabs, the noble Baroness makes me want to check my notes. In my briefing it says emphatically that flu and Covid jabs can be taken together, but I will take the opportunity of her additional question to offer to write confirming that point in case I have got it wrong.

[Baroness Barker (LD)]

My Lords, throughout the pandemic, epidemiologists have been clearly telling us that when restrictions are eased, there will inevitably be further outbreaks, some of them localised. For the past 15 months, test, trace and isolate has been a shambles. Can the Minister explain what will be done over the summer to improve test, trace and isolate and improve the information going, in real time, to local authorities and to other parts of the NHS, in order that we can move swiftly, as necessary, to very localised lockdowns when that proves necessary for public health?

[Lord Bethell (Con) [V]]

I completely agree that the post-lockdown wave is a well-known phenomenon, and we are living through the pain of it right now. I do not agree that test, trace and isolate is a shambles, and if the noble Baroness really still feels that way, I would be glad to arrange a briefing for her. As for what more we can do, we are investing heavily in the system and we will continue to improve things, as we have done already.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, on 28 June, the Secretary of State said that the lifting of restrictions in July would be “irreversible”, but the Minister will know that the SAGE meeting of 7 July said that all modelled scenarios show a period of extremely high prevalence of infection, lasting at least until the end of August. It identified four risks associated with high infection, including an increase in hospitalisations and deaths. If there is a risk of the NHS being overwhelmed, surely the Government will have to consider some more lockdown restrictions.

[Lord Bethell (Con) [V]]

My Lords, the noble Lord, who is so wise in these matters, has answered his own question. If necessary, we will do what it takes, but the aspiration is clear: we are seeking to get the vaccination level to such a high rate that R is below 1 and no further lockdowns are necessary. That is an honourable, reasonable and epidemiologically sound objective.

[Lord Scriven (LD)]

My Lords, the Secretary of State for Health and Social Care is living proof that, despite having two jabs, 20% of individuals can catch and be spreaders of coronavirus. If this is the case, why are the Government, as a matter of policy, going to use internal Covid passports as a public health measure to deal with the virus in large venues? At best, they will give individuals and venues a false sense of security. At worst, for those who are double jabbed, infected but asymptomatic, they will be useless in the fight against the spread of this disease.

[Lord Bethell (Con) [V]]

My Lords, this is the clinical advice given to us by clinicians. I cannot answer the whole question in the round in this brief session, but a number of considerations include not only that vaccines offer a significantly reduced rate of infection but that the level of infection is much lower, the viral load is much lower, and therefore the infectiousness is much lower. The aggregate effect is that a group of people who have been vaccinated, with a few who have the disease, is less infectious than a group of people who have been tested, however good the test.

[Baroness Altmann (Con)]

My Lords, I echo the words of appreciation for my noble friends Lady Penn and Lord Bethell and congratulate them on all the work they have been doing. I also want wholeheartedly to support the aims of the policy that we have now, with so-called freedom. Indeed, I encourage the Government to consider going even further. This is about managing risk, not just of Covid but of all other illnesses, so I have to ask, having listened to this debate, when will be the right time? If all the most vulnerable and two-thirds of all adults are vaccinated, and if the mass numbers of infections do not lead to mass hospitalisations and deaths, and if zero Covid is unachievable, when will we learn to live with the virus and stop government interference with individual citizens’ lives in the way that has been, in my view, so frightening over the last period?

[Lord Bethell (Con) [V]]

I am grateful for my noble friend’s kind remarks. Her question is extremely complex, and difficult to answer briefly but I will rest on one particular answer. As I said before, this is a question of getting the disease transmission to a point where R is below one. If that can be done on a national basis, we have contained the disease. We can then turn to local outbreak management. That is when test and trace resources will come into their own and local deployment will make a big difference. That is when we can consider the virus to have been beaten. We are not quite there yet, but vaccination rates are incredibly impressive and I am hopeful that we are near to that point.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the Statement given in the other place said that

“our wall of protection must be more than just vaccines alone”.—[Official Report, Commons, 19/7/21; col. 688.]

Yet it made no mention of ventilation despite its obvious importance, given that I am hearing, as I am sure many others are, about double-vaccinated people becoming infected every day, and about the widespread transmission of Covid-19 in schools among children of all ages. The noble Baroness, Lady Thornton, asked, without answer, whether air filtration was being installed over the holidays in every school. I add—this could be done rather more cheaply—can schools be given help over the summer to do a ventilation plan for every classroom? Strategic placement of fans, and the choice and manner of window-opening, could be crucial. I see from media reports that the Government plan to replace the “hands, face, space” slogan with the slogan “keep life moving”. If it is not too late, may I suggest that “keep air moving” would be far more useful?

[Lord Bethell (Con) [V]]

I am grateful to the noble Baroness for giving me an opportunity to address this issue, and I hope the noble Baroness, Lady Thornton, will forgive me for overlooking it in my opening answers. The noble Baroness, Lady Bennett, is entirely right: ventilation is critical—but it is also challenging. On air filters, we have to understand better the science of whether filtration really makes an impact on the spread of the virus. I would not want investment in a large amount of ventilation infrastructure that did not actually have an impact. I agree that we have a lot to learn from the Victorians, who understood these matters very well. We must understand how modern buildings, which are often airtight to achieve environmental qualifications, may need to be adapted to get fresh air within them. We may also need to change our lifestyles, so that more socialising, eating and drinking is done outside—something that I, as an outdoorsy person, would very much welcome.

[Lord Taylor of Goss Moor (LD) [V]]

I am sure that the Minister is alive to the fact that the beta variant is less susceptible to the AstraZeneca vaccine in particular, with effectiveness as low as 10%. Perhaps, therefore, he found it understandable that the Government put further restrictions on travel from France. However, could he explain why we are not doing it with Greece, where the levels of that variant are higher than in France, or Spain, where they are much higher than in France?

[Lord Bethell (Con) [V]]

The noble Lord makes an important and serious point—but could I just address one matter first? The AstraZeneca vaccine has very low efficacy on a single dose against beta—around 14% or 15%—but on two doses its effectiveness is significantly higher. None the less, his broad point is right. As we vaccinate the nation, the variants that escape the vaccine will gain a natural advantage, and those will be the ones that begin to outperform the highly infectious variants such as delta that work so well among the unvaccinated. When it comes to travel, the analysis is complex. We have taken a precautionary approach with France, which I think is right, because there is a large amount of beta in France, but we are looking at all countries all the time, and we will take whatever steps are necessary to protect these shores.

[Baroness Fox of Buckley (Non-Afl)]

Following on from the noble Lord, Lord Scriven, I want to ask specifically about the surprise in the Statement: the need for vaccination passports in nightclubs and other venues with large crowds gathering. It was a surprise because last year the Prime Minister called vaccine passports unnecessary and intrusive. More recently, the Vaccines Minister called them “discriminatory” and Matt Hancock, when in office, declared that they were a step too far and said that

“we’re not a papers-carrying country”.

It seems as though we are, because this is about making young people’s engagement in public life contingent on papers. Would the Minister comment on whether this rowing back on previous statements will fuel cynicism among the young and the conspiratorial thinking that, “You said you wouldn’t do it and now you’ve done it”? Some Conservatives told me that I am not to worry, that it will not happen and that it is just a plan to threaten the young into compliance. Can the Minister clarify that?

If nightclubs, football grounds, pubs and so on require vaccine passports, does that mean that bar staff, cleaners, bouncers, groundsmen et cetera will need proof of vaccination to keep their jobs? I am worried about another group of workers having vaccines mandated, this time in the hospitality industry.

Finally, does

“other venues where large crowds gather”

include political conferences? I am asking for a friend or two.

[Lord Bethell (Con) [V]]

My Lords, I make no apology for changing my mind during the pandemic. I will admit readily to the House that I have changed my mind and rowed back on all sorts of things that I thought I was certain about. It has been a learning experience, to put it politely, for all of us, and we have all had to adjust our thinking on lots of matters as the evidence and the impact of the virus have affected us greatly. So, no, I do not believe in conspiracy theories, as the noble Baroness specifically asked me.

We all have to be responsible for the fact that our health touches on those we sit next to and share air with. This is a public health truism that is self-evident and has become highly apparent. There is no way out of this pandemic other than through the vaccine; there is no other silver bullet. Therefore, we all have a personal responsibility to ensure that we are as safe as possible when we share space with other people. That is the principle with which we go into this and which we are applying when it comes to domestic certification. The guidelines and precise details have not been hammered out yet, but we will do it in a way that seeks to be as inclusive as possible and is considerate to many of the concerns that the noble Baroness quite rightly articulated.

[The Deputy Speaker (Lord McNicol of West Kilbride) (Lab)]

That brings us to the end of the Oral Statement. All questions have been asked.

Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021

Lord Bethell Excerpts

Tuesday 20th July 2021 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 17 June be approved.

Relevant document: 8th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument). Considered in Grand Committee on 12 July.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

I beg to move.

Amendment to the Motion

Moved by

--- Later in debate ---

[Lord Scriven (LD)]

My Lords, we on these Benches support the principle of this SI. Of course we want to see a mandatory standard for tests. I do not think anyone who spoke in Grand Committee argued against the principle of the SI, but there are concerns about a few issues in it. The Minister replied to the issues raised in Grand Committee with soothing words rather than convincing answers, hence the noble Baroness, Lady Thornton, has tabled her amendment to the Motion today.

I want to raise a few of the issues that the Minister either ignored by not answering or used soothing words about but did not give convincing answers to. The first question is: if we are to have a mandatory standard for tests, why have we got new Clause 39A, which is an exemption from the mandatory tests and standards that can be applied at the stroke of a ministerial pen? What is the point of having a mandatory standard for safety if the Secretary of State, at the stroke of his or her pen, can decide to do away with that? In what circumstances and for what reasons would the Secretary of State wish to bring in tests that would lower the mandatory standard, and how would the public know that they were purchasing a test that did not meet the statutory standard that had been set?

I want to address the issue of openness and transparency, as raised by the noble Lord, Lord Alton, and the noble Baroness, Lady Thornton, regarding the validity of the standard of the test as well as human rights issues. Where is the research in public on the validity of the standard of the lateral flow tests, particularly the one from China brought in via Innova, the main intermediary for a Chinese company? This test, as raised in Grand Committee, was given a class I notice in America, and an FDA email says it is not effective and gives the instruction:

“Destroy the tests by placing them in the trash”.


That is the same lateral flow test bought for billions of pounds by the UK. Again, there were soothing words from the Minister in Grand Committee about this: he said that the Government were working with the FDA. That might be true but having two differing positions— the Government saying that the test is safe while the FDA says to throw it in the trash—is not working together. Could the Minister elucidate on why the British Government still feel these tests are safe when the FDA says they should be thrown in the trash? Which part of the FDA’s analysis do the Government disagree with?

The key issue for me is the one that the noble Baroness, Lady Thornton, has already raised: this is not linked into the total public health system to deal with the virus. The key issue is not the standard of the tests themselves but that it should be linked into test and trace. To say that we are going to have a high standard without linking it into the test and trace system is like saying you want the best electric car in order to be environmentally friendly, buying it and then, once you get it home, realising that the nearest charging point is 100 miles away. This is not fit for purpose. To be so, tests must be integral and integrated into the test, trace and isolate part of the public health response to coronavirus.

I ask the Minister, as I and others did in Grand Committee: if someone carries out a private test, how does that link into test and trace? There is no mandation anywhere in UK law to say that a private test, once proved positive, has to be fed into the test and trace system. All the evidence suggests that the way to deal with the virus most effectively is to break the chains of transmission within 48 hours. If tracing is not told that you have tested positive, there is no way to have an effective public health response. So, even if you have the best standard of tests, with no tracing or isolation the chain of transmission will continue.

When I and others asked in Grand Committee, the Minister said that this is also a significant public health policy change. I am not aware of any infectious disease anywhere in the UK or in the world where a market approach to the testing of infectious diseases has become the bog-standard approach, but that seems to have been the Government’s policy after September.

The Minister mentioned Germany in Grand Committee, saying that that country had moved to a specifically private-led testing system. There are two differences in the German system. First, it is controlled by state subsidies; to do it, the companies get a state subsidy, which has now been reduced significantly so the level of private testing is levelling off. Secondly, and most importantly, there is a mandatory requirement in German law to report positive cases from those positive tests to the national Covid test and trace system in Germany.

This statutory instrument, while well intentioned, is riddled with weaknesses. It is not linked to the test and trace system and will not help keep the country safe. It will not have the desired effect, and we will end up with a system that basically has a good standard of tests but then does not do the next, vital part, which is to trace people and then support them in isolating.

That is why we on these Benches will support the amendment to the Motion tabled by the noble Baroness, Lady Thornton—unless the Minister can come up with convincing answers this time, not just soothing words.

[Lord Bethell (Con) [V]]

My Lords, I thank the noble Baroness, Lady Thornton, for her support for the regulations in the round, for her supportive words about the role of the private sector in the round and for raising many important points in her amendment to the Motion, stressing the vital role of NHS testing as we continue to manage the pandemic.

I want to clarify that these regulations are not connected to the future of free NHS testing. This SI, as noble Lords have noted, is solely focused on ensuring the quality of any Covid test in the UK and that they are of the same standards as I would procure for the NHS.

It is self-evident that poor-quality tests, when used privately, could pose a risk to the health of not only the individual but the public. All that is necessary for entry of Covid test products into the UK market is controlled by EU CE marking, which, as noble Lords noted, is currently a self-declaration process for most Covid-19 tests on the UK market. The performance declaration made as part of this EU marking does not need to be independently verified ahead of sale of such tests. There is no legally binding agreed process for establishing performance. That just is not good enough. It became clear as I sought to procure tests at scale for the national effort that many kits that had passed a CE mark were not fit for the real world. I say to the noble Lord, Lord Hunt, that it is not right that the quality of tests correlated to any particular nation; this applied to all nations.

I say to the noble Lord, Lord Alton, that we have audited the supplies of medical devices and there are no current slavery or human rights concerns. We do, however, remain vigilant. I regret that his question on sourcing has not been answered, particularly because there is a very large amount of public material on the procurement framework, the suppliers to it and the arrangements we make to run that framework. I will address that gap with speed, and with regret.

I reassure the noble Lord, Lord Scriven, that there is a very large amount of published material on the internet on the validation of tests, including the protocols and the results from Oxford University and Porton Down, which conducted the validation of the tests. These validation protocols have been assessed by a very large number of experts, and I would be glad to send him links to the protocols and the assessment processes. I reassure him that our tests have been tested against alpha, beta, gamma and delta variants and successfully detect all of them.

The noble Lord, Lord Alton, referenced “kickbacks” to the Communist Party. I very kindly and respectfully ask him to remember that British officials have operated a remarkable procurement programme during the pandemic at the very highest standards of integrity. I gently ask him to provide evidence for such accusations before making them in the House.

To the question of why we buy so many tests from China and not from Britain, the simple answer is that they pass our protocol and meet the requirements of the procurement framework regarding quantity, speed and product design, for example. We buy them to ensure a good deal for taxpayers and effective tests for the public.

I completely agree with the noble Lord, Lord Hunt, that we need a strong UK manufacturing base. I reassure the noble Lords, Lord Alton and Lord Scriven, and others who have raised this point that we have a major programme on this, with subsidies, expertise and support available. I would be glad to arrange a briefing session to run noble Lords through all the measures we have in place to support the UK diagnostics industry. I believe the high-quality regulations we are discussing today provide the certainty business and investors need to invest in the UK diagnostic system. We need this market to provide additional capacity at the time of the pandemic, to ensure that we have outstanding testing capability while also encouraging innovation.

I was keen to take an evidence-based approach to developing this policy, so we ran a very successful consultation that had a broad range of respondents. Some 73% agreed that mandatory validation of tests prior to entry to the market was the best approach; 88% of those agreed that this should be legally backed; 71% agreed that a validation process would not significantly reduce supply; and 79% agreed that mandatory validation processes will increase safety.

In April this year we launched the universal testing offer, so now anyone in England can access free LFD self-tests by ordering online or collecting then at over 9,000 pharmacies across the country. To reassure the noble Baroness and all noble Lords concerned about this, our recently published road map out of lockdown made it clear that we are keeping in place key protections, including free testing for people with symptoms, but we are standing down the workplace testing regime, as the noble Baroness, Lady Thornton, rightly pointed out, from 19 July.

On the rationale for regulation, I welcome the support of the noble Baroness, Lady Thornton, for NHS tests, which have always been of the highest standard. The objective of the legislation is to ensure that the same high standards for tests that we see upheld when the Government buy them are equally reflected in the testing market for all consumers. That market already exists in this country; over 1,000 providers are already going through the UKAS accreditation process. These tests are being used to enable activity across many areas of the economy, including travel, film, TV production and sport. It is critical that we put in place processes to ensure that these tests are high quality and accurate: that is what this law does.

On the integration of private tests and the NHS test and trace system, I reassure the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, that significant work has already successfully linked private sector testing results with the NHS Covid app, the JBC and test and trace. When a test is conducted by a testing provider, whether public or private, the result of that test, whatever the outcome, is legally required to be reported to PHE as a notifiable disease by the provider. To the noble Lord, Lord Scriven: this is true for a private test or a public test, and I would be glad to send him a copy of the long-standing regulations that make this law. This must be done within 24 hours for all positive tests. Any self-administered test provided by the Government can be reported via our online portal by members of the public. Any positive test reported to PHE will be passed on to our contact tracing system.

The draft impact assessment has now been published in the interest of transparency, as has an impact statement. It is a living document, and we want to make the best analysis available. We intend to update the impact assessment and address the RPC’s comments ahead of the introduction of the second SI in the autumn. I would like to put on record my thanks to the RPC for working so closely with us and at such pace on this matter.

I want to ensure that all tests are available in the UK, whether they are offered by the NHS, a charity or a private provider, and whether they are supplied by a British diagnostic firm or an overseas firm. I thank the noble Baroness for giving me this opportunity to respond to her important points. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I start by thanking the Minister. I feel for the Minister, and I wish him well in his self-isolation, and I congratulate him on his immediate and unfussy decision to obey the ping and the trace system. I hope he is going to have a great summer, because I think he has earned it.

I thank the noble Lords, Lord Hunt, Lord Alton and Lord Scriven, for their support and the questions they have asked. I apologise to the House that we did not put this amendment down in the first place. It should have come straight to the floor of the House rather than going through the Grand Committee first. It was only the gathering concern in Committee that led me and other noble Lords to the conclusion that we needed further discussion about this.

It is not up to the noble Lord, Lord Alton, to prove the veracity of the sources of any goods we purchase through the NHS or anywhere else. If it is being bought by the Government, it is up to the Government to demonstrate that those supply lines are not exploitative and do not use slave labour. That is part of the transparency we are calling for. I do not think the Minister answered very well on that matter.

I am concerned that workplaces, as I suspected, will now have to pay for the testing regime we have. I am somewhat reassured by the noble Lord assuring us that tests have to be fed in through the test and trace system wherever they happen, but I am concerned that, given that workplaces will now have to purchase all those tests, the system will break down quite quickly over the summer. We still have many questions and regrets, so I wish to test the opinion of the House.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021

Lord Bethell Excerpts

Tuesday 20th July 2021 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 22 June be approved.

Relevant documents: 8th and 10th Reports from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, more than ever, the social care workforce demonstrates unwavering compassion and dedication for our elderly and most vulnerable. We are proud of and immensely grateful to them. I pay huge tribute to their tireless work during this pandemic to protect people who are most vulnerable to Covid-19, including their incredible efforts to support the vaccination rollout across the sector, to bring in infection controls and to provide pastoral care during this most heartbreakingly lonely episode.

To date, 1.2 million social care workers in England have been vaccinated. This is an incredible achievement and an important step for staff to protect themselves, their loved ones and the people they care for from becoming seriously ill or potentially dying from Covid-19. However, there is a tipping point here. It is a tipping point of safety when it comes to care homes, where many of our most vulnerable priority-list loved ones live. We are not quite there yet.

SAGE recommends that 80% of staff and 90% of residents should have received their first dose of the vaccine to provide a minimum level of protection against coronavirus outbreaks. We have all been witness to the incredible pace at which vaccination programmes have been rolled out. I am delighted to report to the House that 96% of those living in older-age care homes have received their first dose and 93% their second dose. Meanwhile, 93% of those living in younger-age care homes have received their first dose and 88% their second dose.

In many places, take-up among care home staff is also impressive. Some 87% of those working in older-age care homes have had their first dose and 76% their second dose. This compares with 83% and 73% respectively for staff working in younger-age care homes. However, there is also significant variation at a regional and a local level. Only 65% of older care homes in England are meeting SAGE’s stipulated safety tipping point in the latest published data. This drops to an even more worrying 44% in the London area.

As a result, despite very high levels of vaccination, testing, PPE and other infection control measures, we are still seeing outbreaks in care homes, where residents are incredibly vulnerable to the serious effects of this terrible disease. Since January this year, care homes have tested staff more than 21 million times and made proper use of 1.2 billion items of PPE. Yet nearly 14,000 care home residents have died because of the virus this year alone.

This winter will be challenging and, in the face of rising case rates across the country, we need to make sure that we have done everything we can to prepare and to minimise the risks for residents in care homes and the incredible staff who care for them.

This is the context. It makes this legislation critical. By November this year—and subject to the usual parliamentary approval and, we hope, a helpful and practical 16-week grace period—anyone entering a CQC-registered care home in England must be vaccinated, unless a valid exemption applies. This will apply to all care home workers, agency staff and volunteers. Visiting healthcare workers, tradespeople, hairdressers and CQC inspectors will also be obliged to follow the new requirement.

We have considered this policy incredibly carefully, consulting thoroughly and extensively to get this right both for residents who are so vulnerable to Covid and the staff who go above and beyond in caring for them every day. The policy will therefore apply to all people over 18 who work inside a care home unless they have a medical reason not to be vaccinated.

Further limited exceptions have been made to ensure that this works on the ground. Emergency services, people providing emergency assistance and those undertaking urgent maintenance work can all enter a care home without needing to show that they are vaccinated. Visiting family and friends are also exempt, given the significant well-being benefits such contact provides. While we would always encourage all these people to take up an offer of a vaccine, we have acted on the advice from SAGE that a balance must be struck.

Before I turn to our assessment of the impact this may have on the workforce, I acknowledge the vital role the Secondary Legislation Scrutiny Committee has played in its calls for further details outlining the Government’s current analysis of the expected impact of the draft regulations. Following its eighth report, we made an impact statement available to this effect, and we note the further points raised in its 10th report yesterday. I can also confirm to the House that we will be publishing a full impact assessment as soon as possible.

After everything care home staff have done in the pandemic, we owe them the greatest consideration and respect. We understand that providers and their staff need time to prepare for these changes, which is why the 16-week grace period immediately following the enactment of regulations will allow staff who have not been vaccinated to make arrangements to have both doses. Unfortunately, we recognise that there will be some staff who will choose to leave rather than be vaccinated. Our central analysis estimates that around 7% of current staff may not meet the requirement by the end of the 16-week grace period. This equates to 40,000, out of a workforce of 570,000, who may need recruiting to replace staff who do not meet the requirement.

However, this estimate is very uncertain. We just do not know yet exactly how staff will respond to the requirement, not least because staff turnover in this sector is around a third each year. I am grateful to Professor Martin Green of Care England for talking me through these concerns. Of course, we do not want to lose valuable care home staff who have made an enormous sacrifice over the last year and a half, and we will continue our efforts to drive uptake across the sector. We owe it to ourselves and to their commitment to try our hardest. However, our overriding priority has to be the safety and well-being of the people they care for.

Before closing, I pay a final tribute to all care home staff, past, present and future, who have played a vital role in our nation’s recovery from the pandemic. We did not take lightly the decision to introduce this legislation. However, the risks that this winter will undoubtedly pose to the most vulnerable in our society make clear the choice that we must make: to do everything in our power to protect them. With that sentiment in mind, I commend these regulations to the House. I beg to move.

Amendment to the Motion

Moved by

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, I thank noble Lords for their considered questions and huge interest in the instrument laid before us today. Tragically, there have been more than 30,000 deaths recorded among care home residents during this pandemic. We have a duty to do all we can to prevent further suffering. Testing,PPE and infection prevention can go only so far in the mitigation of risk. Ensuring very high levels of vaccination for people living and working in care homes is an essential public health intervention for a serious vaccine-preventable disease.

To answer my noble friend Lord Lansley, the residential care workers covered by these regulations are handling the most vulnerable and elderly in priority list 1, which is why we started with them. Forthcoming consultations will address those who work with priority lists 2 to 4 and, in response to the noble Baroness, Lady Brinton, we may ultimately consult on extending further into the rest of the health and social care workforce. My noble friend Lord Lansley asked about resources. Our focus has been on ensuring that the social care sector has the resources it needs to respond to the pandemic. On 27 June, we announced a further £251 million of adult social care Covid-19 support, through an extension of the infection control and testing fund.

I say to my noble friend Lady Foster, who spoke with such passion on individual choice, that it is worth bearing in mind that many people are not afforded much, if any, choice in who cares for them. We have heard from people with lived experience of care. They want to know that the person who cares for them is vaccinated. I am not instinctively a supporter of mandatory measures. I note my noble friend’s philosophical points on this with great interest. I am even less keen to impose obligations on those people just at the time when the rest of society is opening up around them. But the noble Baroness, Lady Tyler, put it very well. She made a strong case, with moving personal testimony, that it is right that we protect the most vulnerable, even if it would take us further than we would normally go. We simply cannot be in a position where those most in need of care and the highest level of protection from the threat of Covid face a lottery of risk depending on the level of vaccine uptake by those working in their care. My noble friend Lord Cormack has spoken on this on several occasions extremely movingly.

It is not our intention to compel anyone to take the vaccine against their will. We can, and should, make it an essential criterion for working in care homes—to make it an explicit duty of care, providing peace of mind to colleagues, residents and all who visit. Barchester, a large care home provider with over 16,000 staff, already requires staff to be vaccinated. The evidence there gives us real cause to be hopeful, showing that, having taken the time and effort to engage with employees, understand their concerns and encourage them to take up the vaccine, only 0.5% of staff left the workforce. I reassure the noble Baroness, Lady Wheeler, that there have been huge efforts to drive vaccination take-up among care home staff in recent months already. In response to the noble Baroness, Lady Brinton, and others who have spoken on this point, I would welcome the opportunity to update noble Lords on these efforts, in detail, at a suitable briefing.

We have heard the arguments made by the noble Baroness, Lady Tyler, that social care teams need support. That is exactly why vaccination teams have visited care homes to offer vaccinations to both residents and staff, with actions at the national, regional and local level to improve access and address concerns. To answer the concerns of the noble Baroness, Lady Wheeler, on guidance, I reassure the House that we recognise the need to introduce these changes with the utmost care and sensitivity. To the noble Baroness, Lady Brinton, we are working with representatives from the sector to produce detailed operational guidance to support implementation. The noble Baroness, Lady Tyler, is right that the implementation is complex, so we will also be working with Skills for Care, the charity focused on workforce development, to ensure that guidance and best practice are available to support providers and local authorities. I say to the noble Lord, Lord Campbell-Savours, that the wearing of masks in a care home setting is properly governed by regulations. I reassure him that the guidelines are rigorously enforced.

I will address the heartfelt, tough and, if I may say, challenging remarks of noble Lords on the impact statement. I reassure noble Lords that this Minister, this department and this Government fully respect Parliament, and the scrutiny and challenge brought by Parliament and this House. We have published an impact statement. I say to the noble Lord, Lord Hunt, that there is no question of us trying to hide that. But it is very complex. I hope the House will appreciate that there is an enormous amount about this pandemic that is unprecedented. The noble Lord, Lord Hunt, put it well. We cannot be sure how staff will react to this unprecedented measure. That is what drives the financial model, but how do we know how many will leave the sector or take a lateral move to a non-sensitive role?

Much about the vaccine has confounded expectation. Who would have thought a year ago that the take up of the vaccine among the elderly would be in the mid-90% range, or that the take-up among the young would be incredibly encouraging? As I said, one major care home provider has already brought in such a measure and saw a drop-off of less than 1%. That is why the drafting of the impact assessment has been such a struggle. There is no question of hiding or of misleading the House. We are working with partners to generate the most credible calculations possible. We will publish the impact assessment as soon as possible and we are using this time to hammer out the best estimate we can.

To the concerns of the noble Baroness, Lady Wheeler, I say that it is right that we start with care homes, where residents and staff are the top priority, and we intend to consult further on the rest of health and social care. It is also right to acknowledge the important role of the Joint Committee on Statutory Instruments in considering the regulations. I acknowledge fulsomely the vital role of the Secondary Legislation Scrutiny Committee in scrutinising the legislation and holding the Government to account. We are particularly grateful to the committee for giving us the opportunity to explain the policy in further detail in an evidence session last week.